MEDICARE: DR. JACK MORTON STEIN D.O. M.P.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	OS-4108-L	PA

General Provider Information

NPI Number	:	1760774756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK MORTON STEIN D.O. M.P.H.

Provider Business Mailing Address
First Line	:	520 NORTHWICK LN
Second Line	:
City	:	VILLANOVA
State	:	PA
Zip	:	19085-1835
Country	:	US
Telephone Number	:	610-527-6005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 MARKET ST
Second Line	:	14TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-7501
Country	:	US
Telephone Number	:	215-977-3385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2011
Last Update Date	:	05/09/2011

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